HOW INSTITUTIONAL CONDITIONS SHAPE THE QUALITY OF WORK PRACTICES: EVIDENCE FROM THREE CARE COORDINATION PROGRAMS IN NEW YORK STATE

Abstract

Commentators have often celebrated care coordination as an encompassing solution capable of reducing costs and increasing quality in US healthcare. It is unclear, however, under which conditions organizations implement high-quality work practices that are essential for achieving improved outcomes in the context of care coordination programs. My paper examines two institutional factors that improve the quality of work practices: occupational community, and regulatory intensity. I argue that the interaction of both factors produces higher quality than either would in isolation. I also demonstrate how in the absence of both factors, a prioritization of cost-effectiveness reduces the quality of work practices. To make my argument I draw on 80 semi-structured interviews, 80 documents, and 15 hours of observation in my study of three care management agencies that focus on serving low-income chronic disease patients in one of the most resource-poor communities in New York State.